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Labor - Exam 1 Flashcards

1
Q

What is the technical definition of labor?

A

Uterine contractions that bring about demonstrable effacement and dilatation of the cervix

aka must have cervical change

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2
Q

What are the 5 components of the cervical exam when it comes to labor

A

dilation

effacement

station

consistency

position

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3
Q

What is considered completely dilated?

A

0-10cm

10cm is complete dilation

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4
Q

What is effacement? How is it measured?

A

length of the cervix (how thick it is)

Difference between the internal and external cervical os

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5
Q

What is station? How is it measured?

A

degree of descent of the presenting part of the fetus

Measured in centimeters from the ischial spines and can be measured in thirds

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6
Q

What does a firm cervical consistency equal? What are the different options? What are the different positions?

A

firm cervix means they are NOT in labor

consistency options: soft, medium and firm

position: anterior, mid position or posterior

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7
Q

In order to diagnosis labor, there MUST BE _____. What are contractions without this?

A

cervical change

Braxton Hicks contractions= contractions without cervical change

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8
Q

What is the Bishop Score? **What score is important to remember?

A

used to determine how favorable the cervix is for labor

**score>8 is favorable cervix for labor

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9
Q

Draw the Bishop Score chart

A
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10
Q

How common is the premature rupture of membranes?

A

10% of pregnancies

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11
Q

When should all mothers be screen for Group B Strep? What should you do if positive?

A

> 35 weeks all pregnant women have ano-vaginal swab

PCN before labor

alt: Erythromycin or Clindamycin or Vanc

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12
Q

Why is IV pain medication NOT used in labor?

A

Can cause nonreassuring fetal status and fetal respiratory depression

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13
Q

_____ is used for pain management during labor. Where is it placed?

A

regional anesthesia via epidural that is given as an initial bolus then a continuous infusion is started

placed in L3-4 interspace

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14
Q

What are complications with an epidural?

A

Maternal hypotension
Maternal respiratory depression
Spinal headache

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15
Q

What are the CI for epidural?

A

Maternal bleeding disorder or use of LMWH within 12h

Patient refusal

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16
Q

______ is used for pain management during a c-section

A

spinal anesthesia: one time dose directly into the spinal canal

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17
Q

when is a pudenal block used?

A

Provides perineal anesthesia

Used with operative vaginal deliveries or for extensive perineal repairs after delivery

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18
Q

When is general anesthesia used labor? What are 2 complications?

A

c section in emergent or urgent settings

maternal aspiration
risk of hypoxia to mother and fetus

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19
Q

If the pt’s Bishop score is less than 5, it may lead to _______ approximately ____ of the time. What else needs to happen?

A

failed induction

approx 50% of the time.

Bishop Score <5 indicates need for cervical ripening

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20
Q

When a pt’s labor is induced, what does it do to the latent phase of labor?

A

Latent phase of labor is significantly longer!!

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21
Q

______ help to ripen and dilate the cervix by causing dissolution of collagen bundles and increase water uptake by cells. What are 2 options?

A

prostaglandins

Cervidil –PGE2, vaginal
Cytotec – PGE1, vaginal or oral

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22
Q

What are the SE of prostaglandins used in the induction of labor? Give the 2 names

A

Cervidil –PGE2, vaginal
Cytotec – PGE1, vaginal or oral

Tachysystole, fever, vomiting, diarrhea
Uterine rupture

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23
Q

**What are the CI for prostaglandins?

A

History of cesarean section

myomectomy (peeling tissue from the uterus)

hysterotomy (incision into the uterus)

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24
Q

_____ is given which leads to induce labor by causing the uterus to contract. What is the identical version that is released from the posterior pituitary?

A

Pitocin

oxytocin

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25
What are the SE of Pitocin?
Tachysystole - >5 contractions in 10 minutes Uterine rupture (but not as likely as the prostaglandins) Hyponatremia Hypotension Amniotic fluid embolism
26
What are the 2 CI of pitocin?
Fetal distress hypersensitivity
27
What are the 3 non-medication options for induction of labor?
cervical ripening balloon laminaria artificial rupture of membranes using a hook
28
How does the laminaria work? Where else is it commonly used?
Rolled up seaweed that pulls out water and in turn dilates the cervix used commonly in endometrium ablations
29
What are the 2 types of operative vaginal delivery? What are the indications?
forceps vacuum indications: Prolonged second stage of labor Maternal exhaustion Hasten delivery for fetal compromise
30
What is the current rate of C-section in the US?
32.4%
31
What are the 4 stages of labor?
32
What does the Freidman's curve represent?
Good guideline for expected progression in labor and helps to determine abnormal labor patterns
33
What does Zhang labor curve represent?
Labor progresses similarly for multips and primips until 6cm active phase of labor starts at 6cm, after 6cm multiparas progress much quicker
34
How long is the first stage of labor for a nulliparous pt? multiparous?
Nulliparous patient: 10-12 hours Multiparous patient: 6-8 hours
35
What are the 2 different phases of the first stage of labor?
latent and active latent: From onset of labor with slow cervical dilation to ~6 cm. Slower phase active: from 6cm to complete dilation 10cm with a faster rate of cervical change
36
What are the 3 P's that factor into the active stage of labor?
Power – uterus Passenger – fetus Pelvis – baby has to fit out of
37
To assess power of uterine contraction, ______ can be used. To assess activity of contractions ______, _____ or ______ can be used
Intrauterine Pressure Catheter observation of the mother palpation of the fundus external tocodynamometry
38
What frequency is considered adequate labor? Give general and specific options
Generally 3-5 contractions in a 10 minute period is considered adequate labor OR Adequate labor > 200 Montevideo units in 10 min (must use IUPC to measure in Montevideo units)
39
What are 4 different passenger variables that can affect labor?
macrosomia fetus lying longitudinal, transverse or oblique
40
What does a compound fetal presentation mean? Funic?
compound: something in front of the baby-arm funic: umbilical cord
41
if a baby is funic presentation, what should you do next?
go straight to C-section
42
What is Leopolds maneuver? What 3 things make it harder?
abdominal palpation to determine Fetal lie Estimate fetal weight Fetal position Fetal presentation Difficult if mother is obese, polyhydramnios or multifetal gestation
43
Any position other than _____ usually results in a cesarean delivery. What is the weight cuttoff?
vertex Fetus suspected to be greater than 5000 grams -> consider C section DM: greater than 4500 grams -> consider C section
44
Small pelvic outlet can result in _________ and can indicate _____
cephalopelvic disproportion indicates cesarean delivery
45
_____ is the ideal pelvic structure for having babies.
gynecoid
46
What is the difference between labor protractions and labor arrest?
Labor protractions – labor progress that is slower than normal Labor arrest – cessation of labor progress despite best attempts at augmentation
47
What is active phase arrest of labor? What do you do next?
no progression in cervical dilation in patients who are at least 6-cm dilated with rupture of membranes despite 4 hours of adequate uterine activity or 6 hours of inadequate uterine activity with oxytocin augmentation c-section
48
What are the risk factors for umbilical cord prolapse? What do you do next?
Artifical rupture of membranes Unengaged fetal head C-section
49
What is the second stage of labor defined by? What are 2 indications of the second stage?
Characterized by descent of the presenting part through the maternal pelvis and expulsion of the fetus pelvic/rectal pressure mother actively pushes
50
What is molding?
Alteration of the fetal cranial bones to each other as a result of compressive forces of the maternal bony pelvis during labor
51
What is considered an abnormal length of the second stage of labor? If the mom decides to keep pushing, this increases the risk of what 4 things?
more than 3 hours of pushing in nulliparous individuals and 2 hours of pushing in multiparous individuals Neonatal acidemia NICU admission Third and fourth degree lacerations Chorioamnionitis
52
What are the different degrees of perineal lacerations?
53
What are 5 complications of an episiotomy? What are the 2 variations of an episiotomy?
Increase vaginal bleeding Increase postpartum pain Unsatisfactory anatomic results Sexual dysfunction Increase risk of infection midline and mediolateral
54
What are maternal risk factors for shoulder dystocia?
Fetal macrosomia Diabetes – overt and gestational Previous shoulder dystocia Maternal obesity Postterm pregnancy Prolonged second stage of labor Operative vaginal delivery
55
What are fetal risk factors for shoulder dystocia? How do you dx it?
Fracture of humerus and clavicle Brachial plexus injuries Phrenic nerve palsy Hypoxic brain injury Death Made when routine delivery maneuvers fail to deliver the anterior shoulder
56
What is McRobert's maneuver? When is it used?
sharp flexion of maternal hips for shoulder dystocia
57
What is Zavanelli's maneuver?
replace infants head back into the pelvis and do a c-section
58
What are different options you could possibly do if a baby presents with shoulder dystocia?
Episiotomy McRoberts maneuver – sharp flexion of maternal hips Suprapubic pressure Delivery of posterior shoulder Symphisiotomy Zavanelli
59
What is the 3rd stage of labor? How long does it usually take?
The time from fetal delivery to delivery of the placenta Usually about 30minutes
60
What are 3 signs of placental separation?
Lengthening of umbilical cord Gush of blood Fundus becomes globular and more anteverted against abdominal hand
61
How is the placenta delivered?
delivered using one hand on umbilical cord with gentle downward traction while the other hand on abdomen supporting the uterine fundus
62
_______ is a risk factor if aggressive traction during delivery of the placenta
uterine inversion
63
What 3 things need to be monitored closely during the 4th stage of labor?
Blood pressure, uterine blood loss and pulse rate must be monitored closely
64
What are 3 causes that increase risk for postpartum hemorrhage? Which one is MC?
**Uterine atony –Most common cause Retained placental fragments Unrepaired lacerations of vagina, cervix or perineum
65
What is considered a postpartum hemorrhage?
Blood loss >500c in a vaginal delivery or >1000cc in a cesarean delivery
66
What is the tx for postpartum hemorrhage?
Removal of placental fragments or repair of lacerations Additional IV access Type and cross match for blood Medications for uterine atony: Pitocin, Methergine, Cytotec, Hemabate
67
What are the 7 cardinal movements of labor?
1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation/restitution 7. Expulsion
68
What is considered engagement? Descent?
Passage of the widest diameter fetal presenting part below the plane of the pelvic inlet. The head is said to be engaged if the leading edge is at the level of the ishial spines Refers to the downward passage of the presenting part through the bony pelvis
69
Describe what is happening during flexion? What part of the baby's head has the smallest diameter?
Occurs passively as the head descends due to the shape of the bony pelvis Complete flexion allows the fetal head’s smallest diameter to fit through the pelvis subocciptobregmatic diameter
70
What happens next after flexion?
internal rotation Rotation of the fetal head from occiput transverse to occiput anterior or posterior position Occurs passively due to the shape of the bony pelvis
71
What is happening in the extension phase?
Occurs when the fetus has descended to the level of the vaginal introitus When occiput is just past the level of the symphysis, the angle of the birth canal changes to upward position
72
What is happening in external rotation/restitution?
As the head is delivered, it rotates back to its original position prior to internal rotation Head aligns anatomically with the fetal torso The release of the passive forces on the fetal head allows it to return to appropriate position
73
Consider watching this video again, maybe?
https://www.youtube.com/watch?v=q1jmVN3ILpY
74
what is a normal fetal heart rate? What is considered bradycardia?
110-160 bpm Fetal HR less than 110
75
What are 2 common causes of fetal bradycardia?
congenital heart block: mothers who have Lupus maternal hypotension
76
What is considered tachycardia in a fetus? What are 2 common causes?
fetal HR above 160bpm infection terbutaline
77
How do you determine what a fetus's baseline heart rate is? What about a fetus's heart rate would make you worry?
Mean bpm over a 10 minute window absence of variation and greater than 25 bpm of variation some variation is normal!
78
What is considered normal fetal heart rate accelerations that is a good thing?
>32 weeks: at least 15bpm and lasting 15s <32 weeks: at least 10bpm and lasting 10s
79
What type of decelerations is normal and is completely fine? What will they look like when compared to the contractions? What is the tx?
Early decelerations Begin and end approximately at the same time as contractions no intervention required
80
What type of decelerations is a problem? What will they look like when compared to the contractions? What is happen? What is the tx?
Late decelerations Begin at peak of contraction and slowly return to baseline after the contraction has finished Result of uteroplacental insufficiency (not enough reserve to keep the babies HR up during the contraction) Position, Oxygen, Stop Pitocin, Check cervix, Fluid Bolus Consider assisted delivery or cesarean delivery with more than 50% of the contractions
81
If the FHR deceleration is due to cord compression, what should you do?
amnioinfusion of saline into the amniotic sac
82
What type of deceleration?
early dips are happening at the same time as contraction HR is the top strip and contractions strip is on the bottom
83
What type of deceleration?
early
84
What type of deceleration?
late
85
What type of deceleration?
late contraction, then heart tone does down
86
What type of deceleration?
variable will look like "V" shaped
87
What type of deceleration? What is the MC cause?
Sinusoidal fetal anemia VERY BAD!! need to delivery immediately
88
What are the different categories of fetal heart rate tracings?
89
What is the contraction stress test? What do you use? When do you preform this test?
Evaluates the fetal response to a transient reduction in fetal oxygen delivery during uterine contractions Use pitocin to achieve 3 contractions in 10 minutes Evaluate fetal status before induction of labor
90
What is considered a positive (bad), equivocal or negative contraction stress test?
91

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